The Oklahoma Senate bill would require insurance companies to adopt high-tech medical screening tests called biomarker tests

Biomarker testing is a tool doctors use to get a clearer picture of a medical problem – often cancer. Catherine Sweeney

Catherine covers health for StateImpact Oklahoma. She grew up in Muskogee and attended Oklahoma State University. She has covered politics and politics in Colorado’s High Plains, Oklahoma City and Washington, DC. You can reach her at [email protected], @cathjsweeney on Twitter, or 405-673-5226 on Signal.

After Carla Prothro quit smoking, she went for a check-up.

“The doctor said, ‘Well, let’s go to one of those lung cancer screenings,'” she said. “And I was like, ‘OK, yeah, sure.'”

She hadn’t had any worrisome symptoms – no cough, no chest pains. It was just to be safe.

“The scan came back and showed about a tennis ball-sized tumor in one lung — on the left side,” she said. “Maybe an inch-sized tumor in the right – lower lung. Just based on X-rays, they automatically said, ‘It’s stage four, we’re sure the big guy in the left lung caused the little guy in the right.’”

If this had happened a decade or two earlier, this might have been the end of diagnostics before a treatment plan was created.

“But what happened was they did biomarker testing,” Prothro said. “In short, it showed them that I had two primary cancers. It hadn’t spread.”

Biomarker testing is a tool doctors use to get a clearer picture of a medical problem – often cancer. Biomarkers are proteins, genes, or other substances in a sample that give doctors clues about patient needs. In Prothro’s case, her samples showed two different types of cancer that needed to be treated differently.

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The practice has evolved since the 1970s, but this evolution has accelerated in recent years. Providers and patients say getting insurance companies to cover the costs can be difficult. Oklahoma lawmakers are working to change that. Health and Human Services Chairman Paul Rosino authored Senate Bill 513.

“We’re going to ask for insurance now,” he said at the committee hearing. “This expands beyond just cancer. It’s geared towards so many other possibilities for other treatments that aren’t covered.”

He mentioned specific other conditions where biomarker testing can be helpful, such as multiple sclerosis and Alzheimer’s.

Doctors can use biomarkers to learn more about the specific condition of patients with many diseases, but cancer is a good example because it is so difficult to treat. First, cancer is not really a disease. It is a group of more than 100 diseases. DNA is designed to tell the cells in our body when to stop growing and replicating. For example, “We’ve made enough skin cells.” But when someone has cancer, something has gone wrong and the shutdown no longer works. Because cancer affects DNA, each case is unique.

dr Robert Mannel is Director of the Stephenson Cancer Center at OU Health. He says biomarker testing is often used in cases like Prothro’s, where the information helps create a more targeted treatment plan. But there are a number of other ways oncologists can use these tests.

“We often use biomarkers to determine if someone is responding to their therapy,” Mannel said. “And so there could be a biomarker that’s a blood test that — while I’m giving therapy, whether it’s radiation, surgery or chemotherapy — that marker drops off? That tells me I’m doing the right thing.

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There can be a major hurdle for patients:

“Well, these tests cost several thousand dollars,” he said. “So with an insurance company, there was always a tendency to want to say, ‘No, I don’t want that.'”

But the need for these tests — particularly for cancer patients — is not uncommon.

“Nobody wants to have cancer,” he said. “It will affect every second man in Oklahoma and every third woman in Oklahoma. It’s a big problem. And even today, with the advanced technology and therapies that we have, one in three people who are diagnosed with cancer will die from their disease.”

Matt Glanville is the Oklahoma Government Director for the Cancer Action Network, which reports to the American Cancer Society. More than a dozen states — including several neighboring states to Oklahoma — are considering similar bills.

“We honestly don’t want to risk falling behind our region by offering these treatments and covering these treatments for Oklahomans,” he said.

Prothro says she hopes Oklahoma lawmakers will pass the law to ensure coverage for people in situations like hers.

“It’s amazing that I’m still here,” she said. “I think I’ll be here for a long time… because of the biomarker tests and because of the treatment I’ve received.”

The bill passed the Senate with near-unanimous support and will go to the House of Representatives.
For StateImpact, I’m Catherine Sweeney.